Skip to main content

Full text of "Getting a second opinion before surgery : your choices and Medicare coverage"

See other formats


Getting a Second 
Opinion Before Surgery 



Your Choices and Medicare Coverage 



What is a second opinion? 

A doctor may tell you that you need surgery 
for a health problem that is not an 
emergency. This means that the surgery 
does not have to be done right away. That 
means you have time to talk with your 
doctor and decide what is best for you. 
Deciding what is best for you could be 
getting a second opinion from another 
doctor. A second opinion is when another 
doctor gives his or her view about your 
health problem and how it should be 
treated. 

Doctors do not always agree on when 
surgery is the best choice of treatment. You 
have the right to: 

• Know what your choices are. 

• Have another doctor look at those 
choices with you. 

• Have your wishes considered before 
choosing surgery. 



Wiien sfiouid 1 get a second 
opinion? 

Do not wait for a second opinion for 
emergency surgery. Some types of 
emergencies that may require surgery right 
away include: 

• Acute appendicitis 

• Blood clot or aneurysm 

• Accidental injuries 




It is up to you to decide when and if you 
will have non-emergency surgery. Getting a 
second opinion can help you make a more 
informed decision. For example, the 
following procedures are not always 
emergencies: 

• Tonsillectomies 

• Gall bladder procedures 

• Hysterectomies 

• Hernia repairs 

• Cataract operations 

You may also get a second opinion if your 
doctor tells you that you should have 
certain kinds of major non-surgical 
diagnostic or therapeutic tests. 

How do 1 net a second opinion? 

When you decide you want a second 
opinion, ask your doctor's office to send 
your medical records to the doctor giving 
the second opinion. That way, you may not 
have to repeat medical tests. 

Before you visit the second doctor, call that 
office and make sure they have your 
records. During the visit, be sure that the 
doctor knows what tests you have had and 
what surgery you want to discuss. 

If the second doctor does not agree with the 
first, you may feel confused about what to 
do. In that case, you may want to: 

• Talk about your condition more with your 
first doctor. 

• Talk to a third doctor. 



MEDICARE • MEDICAID 

Health Can Flnancjng Admlnlttration 



:2-07-13 
■'.00 C'Sciii'fty Bivd. 



Publication No. HCFA-02173 
AAay2000 



What do I need to know before I 
get a second opinion? 

When surgery is not an emergency, you may 
want to ask the doctor questions about your 
health problem and the surgery. It may help 
to write down a list of questions. Take the 
list of questions with you to the doctor. To 
help you with making your list of questions, 
you may want to call 1-800-MEDICARE (1- 
800'633'4227), and ask for Choosing 
Treatments. 



How do I find a doctor to give 
me a second opinion? 

• Ask your doctor for the name of another 
doctor to see. Do not hesitate to ask; 
most doctors want you to get a second 
opinion. If you do not want to ask the 
doctor who recommends the surgery, ask 
another doctor you trust for the name of a 
doctor to see for a second opinion. 

• Ask your local medical societies for the 
names of doctors who treat your illness or 
injury. Your local library can help you 
identify these societies. 

• Call the Medicare carrier who handles 
your Medicare Part B bills. Your carrier 
can give you the names of doctors in your 
area who accept assignment (accept the 
Medicare approved amount as payment in 
full). This could save you money. For 
additional information on "assignment", 
refer to the Medicare pamphlet: Does your 
doctor or supplier accept "assignmentr. 

To find your Carrier's name, address, and 
telephone number: 

• Look in the Medicare & You handbook. 

• Call 1'800-MEDICARE (1-800-633- 
4227) or TTY/TDD: 1-877-486-2048 for 
the hearing and speech impaired. 

• Look on the internet at wiuw. medicare. gov 
under "Helpful Contacts." 



ens LIBRARV 




3 flOTS □DOlOTLfl B 

How does Medicare pay for a 
second opinion? 

Medicare Part B helps pay for a second 
opinion just as it helps pay for other doctors' 
services that are medically necessary. 

If you have Medicare Part B and are in the 
Original Medicare Plan: 

• Medicare pays 80 percent of the approved 
amount for a second opinion. Your share 
is usually 20 percent of the Medicare 
approved amount, after you have paid 
your $100 annual Part B deductible. 

• If the second opinion does not agree with 
the first. Medicare pays 80 percent of the 
approved amount for a third opinion. 

If you are in a Medicare managed care plan 
(such as an HMO), you have the right to 
get a second opinion. But some plans will 
only pay for a second opinion if you first get 
a referral from your primary care doctor. (A 
referral is a written OK). You must get the 
second opinion from the doctor named in 
the referral. If you want to get a second 
opinion from a doctor who does not belong 
to your plan, talk to your plan first. Some 
plans will pay if you do this, but most will 
not. 

If you are in a Private Fee-for-Service plan a 
second opinion for your health problem is 
covered by Medicare. If the first two opin- 
ions are different from each other, the 
Private Fee-for-Service plan will pay for a 
third opinion. 

If you have Medicaid, it may also pay for 
second surgical opinions. To find out, 
contact your State medical assistance office. 
You can get the phone number by: 

• Looking in the Medicare & You handbook. 

• Calling 1-800-MEDICARE (1-800-633- 
4227) or TTY/TDD: 1-877-486-2048 for 
the hearing and speech impaired. 

• Looking at www. medicare. gov. under 
"Helpful Contacts."